MEDICARE: RAMONA LEIGH ROACH-DAVIS CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-096146	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689627994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMONA LEIGH ROACH-DAVIS CRNP

Provider Business Mailing Address
First Line	:	3081 LORNA RD STE 101
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35216-4509
Country	:	US
Telephone Number	:	205-979-3381
Fax Number	:	205-979-3726

Provider Business Practice Location Address
First Line	:	774 SHADES MOUNTAIN PLZ
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-1513
Country	:	US
Telephone Number	:	205-979-3381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/24/2023

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